Biologic Therapy in Pregnant Women with Plaque Psoriasis: A Narrative Review of Maternal and Fetal Safety Considerations.

Background: Psoriasis in pregnancy is a highly prevalent inflammatory condition worldwide, with patients asking how the disease itself, as well as the medications that they take, would affect the general health of the fetus and the course of pregnancy. Objectives: This narrative review aims to explore the effects of biologic efficacy and safety on the pregnancy of women with psoriasis and on their fetus. Methods: A literature search based on biologic therapy, plaque psoriasis and pregnancy terms was conducted. Eleven articles were chosen after screening based on the inclusion and exclusion criteria. Results: The study recorded 290 pregnancies with psoriasis on biologics across 11 case series, resulting in 211 healthy live births (approximately 72.7% of pregnancies). Ustekinumab is the most extensively studied biologic therapy during pregnancy, with 241 reported pregnancy cases, compared with 42 cases documented for anti-TNF therapies. Most of the biologics were paused early in pregnancy, while 24 pregnancy cases under biologic treatment throughout pregnancy were detected. Most of those cases were under Certolizumab and Adalimumab in a percentage of 33.3% each. Among the 290 biologic-exposed pregnancies included in the analysis, 33 spontaneous abortions, 20 elective terminations, 17 preterm births, four stillbirths, eight low-birth-weight infants, and four congenital anomalies (three unspecified and one case of fetal exencephaly) were reported, but without biologic exposure timing and biologic-specific correlations. Certolizumab was considered to be safe throughout pregnancy with minimal incidence of adverse effects, in accordance with existing guidelines. Conclusions: Current evidence indicates that biologic therapy use during pregnancy among women with psoriasis is generally associated with favorable maternal and fetal outcomes. Reported rates of miscarriage, congenital anomalies, and live births appear to be comparable with those observed in the general population and in other inflammatory conditions. Further large-scale, prospective registry studies are needed to clarify whether specific biologic treatment approaches influence pregnancy outcomes and to support more evidence-based clinical decision-making.